A bleak picture of a mental health service that tolerates bullying and houses children alongside adults in breach of guidelines is revealed in a damning report from a government monitoring body. The Mental Health Act Commission claims many more patient deaths will occur through inadequate staffing and lack of training.
The 248-page study, the last by the commission before it is replaced by the new Care Quality Commission, highlights how patients put on suicide watch are often poorly observed, leading to tragedies half-concealed by "falsification" of nursing records.
"One patient found hanging in 2007 was reported to show signs of rigor mortis (not usually noticeable until around three hours after death)," the commission notes, "despite ... being subject to 15-minute observations."
In one medium secure unit a young man strangled himself with a sheet while supposedly under observation every five minutes. It was a busy ward with 15 others being watched. "To achieve such a workload, the health care assistant would be required to observe each patient in her care on a 25-second rotation throughout her shift: a physical impossibility, especially as patients moved around the unit," the report comments.
"One handover note seen by a commissioner appeared to record the deceased patient as 'settled' on the night after he had died." Twenty of the 54 patients who hanged or strangled themselves on hospital psychiatric wards between 2005 and 2008 had been due to be checked at 15-minute intervals or even more frequently.
On restraint deaths, where restive patients are held face down and inadvertently suffocated, the commission suggests staff have not been instructed in alternative techniques to avoid the well-known risks of over-zealous physical intervention.
"We are not confident that staff ... have sufficient training or support to rule out further tragedies," the document warns. "Three inquest findings from 2008 underline that a lack of training and staff knowledge contributed to the deaths of these patients."
Mixed-sex psychiatric wards are a particular concern, generating a culture "where women are subject to low-level harassment and exposed to men who may take advantage of them". Women patients often report feeling "unsafe and vulnerable". Single sex wards should be considered, the commissioners propose.
Government promises about keeping children out of adult wards have already been broken, the document says. "In the four months between 31 October 2008 and 28 February 2009, we received 80 notifications of the admissions of under-18-year-olds to adult facilities," the report points out. "Four admissions of 15-year-old patients took place in 2009, and thus breached the government commitment to end admissions to adult wards of under-16-year-olds from November 2008. All four cases were female."
Of staffing levels, the study remarks: "we have ... observed in some hospitals levels that we have judged - often with the agreement of staff on the shift concerned - to have been unsafe. We continue to see this in some services."
The report - Coercion and Consent: Monitoring the Mental Health Act 2007-2009 - describes the routine in one East Midlands unit of stripping women patients naked, to ensure they are not concealing any means for inflicting self-harm, as undignified and contrary to codes of practice.
Acute psychiatric wards are singled out for abrasive attention: a year-long consultation with psychiatrists, service users and carers "confirmed our criticisms in stating that many inpatient units are unsafe, overcrowded and uninhabitable".
Baroness Young, chair of the Care Quality Commission, endorsed the commission's critique but said that mental health care was "one of the most difficult areas of care in this country. It's never going to be an easy area."
She called for "proper accredited schemes" to train hospital staff in safe restraint techniques and deplored staff shortages in mental health units that restrict activities for patients. "If they don't have enough stimulus, it's a pretty nihilistic [life]."
Source : The Guardian online.